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Soc Sci Med. 2014 Sep;116:56-63. doi: 10.1016/j.socscimed.2014.06.030. Epub 2014 Jun 24.

How might healthcare systems influence speed of cancer diagnosis: a narrative review.

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School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Wolfson Research Institute, Thornaby on Tees TS 17 6BH, UK. Electronic address:
School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Wolfson Research Institute, Thornaby on Tees TS 17 6BH, UK.
Department of Public Health, Bartholins Allé 2, Building 1260, 8000 Aarhus C, Denmark.
The King's Fund, 11-13 Cavendish Square, London W1G 0AN, UK.


Striking differences exist in outcomes for cancer between developed countries with comparable healthcare systems. We compare the healthcare systems of 3 countries (Denmark, Norway, Sweden), 3 UK jurisdictions (England, Wales and Northern Ireland), 3 Canadian provinces (British Columbia, Manitoba, Ontario) and 2 Australian states (New South Wales, Victoria) using a framework which assesses the possible contribution of primary care systems to a range of health outcomes, drawing on key characteristics influencing population health. For many of the characteristics we investigated there are no significant differences between those countries with poorer cancer outcomes (England and Denmark) and the rest. In particular, regulation, financing, the existence of patient lists, the GP gatekeeping role, direct access to secondary care, the degree of comprehensiveness of primary care services, the level of cost sharing and the type of primary care providers within healthcare systems were not specifically and consistently associated with differences between countries. Factors that could have an influence on patient and professional behaviour, and consequently contribute to delays in cancer diagnosis and poorer cancer outcomes in some countries, include centralisation of services, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems. It was not possible to establish a causal correlation between healthcare system characteristics and cancer outcomes. Further studies should explore in greater depth the associations between single health system factors and cancer outcomes, recognising that in complex systems where context is all-important, it will be difficult to establish causal relationships. Better understanding of the interaction between healthcare system variables and patient and professional behaviour may generate new hypotheses for further research.


Cancer; Early diagnosis; Health systems; International comparisons; Primary care

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